Toxic anterior segment syndrome: A review

Surv Ophthalmol. 2019 Jul-Aug;64(4):463-476. doi: 10.1016/j.survophthal.2019.01.009. Epub 2019 Jan 28.


Toxic anterior segment syndrome is a surgical complication characterized by a noninfectious anterior chamber inflammatory reaction having multiple etiologies. The clinical signs (prominent limbus-to-limbus corneal edema, anterior chamber inflammation) and symptoms (decreased visual acuity, discomfort) generally occur within the first 12-48 hours after intraocular surgery. Most patients achieve good clinical and visual outcomes when there is a prompt clinical diagnosis and adequate treatment. We review the literature on toxic anterior segment syndrome, emphasizing its etiology, pathophysiology, and clinical and surgical management, as well as prognosis and sequelae. Our goal is to reduce the frequency of toxic anterior segment syndrome by highlighting the importance of prevention, early recognition, and distinguishing toxic anterior segment syndrome from infectious endophthalmitis.

Keywords: anterior segment inflammation; anterior uveitis; cataract surgery; corneal edema; hypopyon; intracameral solutions; sterile inflammation; sterilization; topical steroids; toxic anterior segment syndrome.

Publication types

  • Review

MeSH terms

  • Anterior Eye Segment / pathology*
  • Diagnosis, Differential
  • Endophthalmitis / etiology
  • Eye Diseases* / diagnosis
  • Eye Diseases* / etiology
  • Eye Diseases* / physiopathology
  • Humans
  • Lens Implantation, Intraocular / adverse effects
  • Lenses, Intraocular / adverse effects
  • Ophthalmologic Surgical Procedures / adverse effects*
  • Syndrome